Taking some painkillers, staying active and doing some specific exercises are generally the most helpful things for people with back pain. However, in some cases there will be further medical treatment needed.
Physiotherapy can be useful to improve your strength and flexibility. A physiotherapist can help oversee your exercise programme and recommend specific exercises to help.
Manual therapies (‘hands on’ treatments), such as manipulation and mobilisation of the spinal joints, can help. These techniques are usually carried out by osteopaths, chiropractors and physiotherapists.
If your back pain is causing problems with daily activities such as dressing, washing and driving, you may find it useful to see an occupational therapist, who may suggest different ways of doing things to reduce the strain or recommend aids or gadgets that will help you. But it’s important that you don’t come to rely on aids or gadgets instead of trying to get back to your daily activities.
If standard painkillers or NSAIDs don't help, your doctor may prescribe stronger drugs. If they prescribe stronger NSAIDs, they'll take precautions to reduce the risk of side-effects – for example:
- by prescribing the lowest possible dose for the shortest possible time, and/or
- by prescribing another drug called a proton pump inhibitor (PPI), which will help protect the stomach.
There is a small increased risk of heart attacks or strokes with NSAIDs, but your doctor will be cautious about prescribing them if there are other factors that may increase your overall risk, for example high blood pressure, smoking or diabetes.
Amitriptyline acts to relax muscles and improve sleep. You’ll usually be prescribed the lowest possible dose to control your symptoms. If the starting dose doesn't work for you then the dose can gradually be increased. This approach will help reduce the risk of side-effects, which may include a dry mouth, drowsiness or blurred vision.
These drugs aren’t usually given as a first-line treatment for ‘ordinary’ back pain. Although they don’t help back pain, they may help sciatica by reducing irritation of the nerves. They may need to be taken for 6 weeks to begin with, and sometimes longer. As with all drugs there can be side-effects, so they won’t be suitable for everyone. You should discuss this with your doctor.
Sometimes steroid injections are useful for back pain or sciatica if other treatments aren't working well enough. These may be given around the nerve roots or into the facet joints.
Fewer than 2% of people with back pain need an operation. Sometimes an operation is needed for spinal stenosis or for severe sciatica to free the nerve, although most doctors would recommend trying other measures first.
Urgent surgery may be needed if you lose bladder or bowel control or the use of your legs, but this is extremely rare.